Anesthesia with Propofol versus Sevoflurane: Does the Longer Neuromuscular Block under Sevoflurane Anesthesia Reduce Laryngeal Injuries?

Abstract

Anesthesia can be maintained with propofol or sevoflurane. Volatile anesthetics increase neuromuscular block of muscle relaxants. We tested the hypothesis, that sevoflurane would cause less vocal cord injuries than an intravenous anesthesia with propofol. In this prospective trial, 65 patients were randomized in 2 groups: SEVO group, anesthesia with sevoflurane, and TIVA group, total intravenous anesthesia with propofol. Intubating and extubating conditions were evaluated. Vocal cord injuries were examined by stroboscopy before and 24 and 72 h after surgery; hoarseness and sore throat were assessed up to 72 h after surgery. Hoarseness and sore throat were comparable between both groups (not significant). Similar findings were observed for vocal cord injuries: 9 (SEVO) versus 5 (TIVA) patients; P = 0.36; the overall incidence was 24%. Type of vocal cord injuries: 9 erythema and 5 edema of the vocal folds. Neuromuscular block was significantly longer in the SEVO group compared with the TIVA group: 71 (range: 38–148) min versus 52 (range: 21–74) min; P < 0.001. Five patients (TIVA group) versus 11 patients (SEVO group) needed neostigmine to achieve a TOF ratio of 1.0 (P = 0.14). Under anesthesia with propofol laryngeal injuries were not increased; the risk for residual curarization, however, was lower compared with sevoflurane.

Comparison of Sevoflurane Inhalation Anesthesia and Total Intravenous Anesthesia with Propofol in Terms of Postoperative Sore Throat and Nausea/Vomiting in Septorhinoplasty Cases

“…It has been reported that postoperative ketorolac is mostly used in patients with sore throat. Mencke et al compared sevoflurane inhalation anesthesia and TIVA with propofol and found the incidence of postoperative sore throat to be 10% in the TIVA Group (20). However, they did not compare this incidence in terms of sore throat severity as in our study.…”

“…In iv techniques, careful titration of these drugs must ensure adequate depth of anesthesia. The intermittent bolus administration of fentanyl may result in unstable states of consciousness during surgery compared to continuous remifentanil infusion (20). Insufficient relaxation or movement due to inadequate depth of anesthesia can also contribute to increased sore throat (9).…”

“…The sample size was determined using G-Power version 3.1.9.4, considering a two-tailed alpha error of 0.05, a power of 0.80, and an effect size of 0.7. Based on these parameters and the N2/N1 allocation ratio of 1 from a previous study (20), 52 patients were determined as the minimum number required for the study. SPSS 21.0 for Windows software (SPSS Inc., Chicago, IL, USA) was conducted for statistical analysis of the data.…”

“…In the studies we reviewed on this topic, we identified several limitations, including long operation duration, insufficient information on analgesic use in the postoperative period (4,9,15,20), and inadequate data on the restriction of head movement that may lead to laryngeal trauma (1,7,12,15). In our study, short operation time, restriction of head movements, controlled administration of propofol and remifentan-fol for both induction and maintenance of anesthesia in elective septorhinoplasty cases may be preferable to inhalation anesthesia with sevoflurane, particularly for reducing the risk of sore throat.…”

Grip strength can be used to evaluate postoperative residual neuromuscular block recovery in patients undergoing general anesthesia

“…Inhalation anesthesia was not adopted in this study, because inhalation anesthesia was found that it can increase the incidence and duration of neuromuscular blockade after surgery. [18] Body weight can also change the distribution volume of neuromuscular blocking in the body, AChE activity, and so on, thereby affecting the muscle relaxation effect. [19] In this study, patients with a body mass index greater than 30 kg/m 2 were excluded from the study.…”